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Published on: August 20, 2007
Utility of HbA1c assessment in people with diabetes awaiting liver transplantation
D Bhattacharjee1, S Vracar1, R A Round2,3,4
1Medical School, University of Birmingham, Birmingham, UK.
Insights
Glycated hemoglobin (HbA1c) levels are unreliable for monitoring blood glucose in diabetic patients with cirrhosis awaiting liver transplant. This is because altered red blood cell characteristics in cirrhosis affect HbA1c readings.
Area of Science:
- Endocrinology
- Hepatology
- Transplantation Medicine
Background:
- Diabetes mellitus and liver disease often coexist, particularly in patients awaiting liver transplantation.
- Accurate glycemic control is crucial for managing diabetes, but certain conditions can interfere with standard monitoring tests.
Purpose of the Study:
- To investigate the relationship between glycated hemoglobin (HbA1c) and random plasma glucose levels in patients with diabetes and co-existing liver disease (cirrhosis) compared to those with diabetes alone.
- To assess the reliability of HbA1c as a marker for glycemic control in diabetic patients with cirrhosis awaiting liver transplant.
Main Methods:
- Collected HbA1c and random plasma glucose data from 125 patients with diabetes but no liver disease and 29 patients with diabetes and cirrhosis awaiting liver transplant.
- Analyzed demographic data, causes of cirrhosis, and erythrocyte parameters (mean cell volume, red cell distribution width, reticulocyte count).
Main Results:
- Patients with cirrhosis and diabetes had significantly lower median HbA1c levels (41 mmol/mol) compared to those with diabetes alone (61 mmol/mol) (P<0.001).
- Random plasma glucose levels did not differ significantly between the groups (P=0.17).
- Lower HbA1c in the cirrhosis group was associated with altered erythrocyte parameters, including higher red cell distribution width and reticulocyte count.
Conclusions:
- Glycated hemoglobin (HbA1c) is not an appropriate test for assessing blood glucose control in patients with cirrhosis and diabetes awaiting liver transplant.
- Altered erythrocyte presentation in cirrhosis interferes with HbA1c accuracy, necessitating alternative glycemic monitoring strategies.
Aims:
To investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease.
Methods:
HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non-alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non-cirrhotic portal hypertension and α-1-antitrypsin-related disease.
Results:
The median (interquartile range) age of the diabetes with cirrhosis group was 55 (49-63) years compared to 60 (50-71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro-Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32-56) mmol/mol [5.9 (5.1-7.3)%] vs 61 (52-70) mmol/mol [7.7 (6.9-8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0-11.2) mmol/l vs 7.3 (5.2-11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α-1-antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=-0.28 and r=-0.26, respectively) in the diabetes group with cirrhosis.
Conclusion:
HbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.
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